Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, GR Doshi and KM Mehta Institute of Kidney Diseases and Research Centre-Dr. HL Trivedi Institute of Transplantation Sciences, Gujarat, India.
Transplantation. 2012 Oct 27;94(8):845-50. doi: 10.1097/TP.0b013e3182664000.
We present our experience of living-donor renal transplantation (LDRT) using pretransplant stem cell transplantation (SCT) where we have successfully achieved minimization of immunosuppression.
Nine hundred sixteen patients underwent LDRT between 2007 and 2011: 606 under tolerance induction protocol (TIP) and 310 with our usual triple immunosuppression of calcineurin inhibitors (CNI), mycofenolate sodium (MMF), and prednisone (controls). The test group (TIP) was stratified into group 1, 1 haplomatch or greater (n=392), group 3, less than 1 haplomatch (n=214); controls were similarly stratified to group 2, 1 haplomatch or greater (n=179) and group 4, less than 1 haplomatch (n=131). The TIP consisted of donor-specific transfusion, adipose tissue-derived mesenchymal and hematopoietic stem cell transplantation, and nonmyeloablative conditioning with total lymphoid irradiation, cyclophosphamide, and rabbit-antithymocyte globulin. Posttransplant IS consisted of prednisone, CNI, or MMF, all in low doses.
Four-year patient survival was 93.5%, 90.7%, 88.7%, and 82.7% in groups 1 through 4, respectively, and death-censored 4-year allograft survival was 94.8%, 95.4%, 94.5%, and 74.6%, respectively. Mean serum creatinine (mg/dL) for groups 1 through 4, respectively, at 4 years was 1.26, 1.57, 1.29, and 2.1. The number of rejection episodes was highest in group 4 and lowest in group 1. Minimization of IS was successfully achieved in 82.9% patients in group 1 and in 61.7% patients in group 3, whereas no minimization in groups 2 and 4. Stem cell transplantations were safe.
Stem cell transplantation is effective in IS minimization in LDRT resulting in good graft function and patient and graft survival at 4 years.
我们介绍了使用移植前干细胞移植（SCT）进行活体供肾移植（LDRT）的经验，在此过程中，我们成功地实现了免疫抑制的最小化。
916 名患者在 2007 年至 2011 年期间接受了 LDRT：606 名患者接受了耐受诱导方案（TIP），310 名患者接受了我们通常的钙调神经磷酸酶抑制剂（CNI）、霉酚酸酯钠（MMF）和泼尼松的三联免疫抑制治疗（对照组）。实验组（TIP）分为 1 组，1 个半相合或以上（n=392），3 组，小于 1 个半相合（n=214）；对照组也分为 2 组，1 个半相合或以上（n=179）和 4 组，小于 1 个半相合（n=131）。TIP 包括供体特异性输血、脂肪组织衍生的间充质和造血干细胞移植，以及全身淋巴照射、环磷酰胺和兔抗胸腺球蛋白的非清髓性预处理。移植后 IS 由泼尼松、CNI 或 MMF 组成，均采用低剂量。
4 年患者生存率分别为组 1 至 4 为 93.5%、90.7%、88.7%和 82.7%，死亡风险校正的 4 年移植物存活率分别为 94.8%、95.4%、94.5%和 74.6%。组 1 至 4 的平均血清肌酐（mg/dL）分别为 4 年时的 1.26、1.57、1.29 和 2.1。组 4 的排斥反应次数最多，组 1 的排斥反应次数最少。组 1 中 82.9%的患者和组 3 中 61.7%的患者成功实现了 IS 的最小化，而组 2 和组 4 则没有实现最小化。干细胞移植是安全的。
干细胞移植在 LDRT 中能有效减少 IS，从而在 4 年内获得良好的移植物功能和患者及移植物存活率。
